An extraluminal migration of a gastrointestinal foreign body to the anterior abdominal wall: A rare case report.

INTRODUCTION: Ingested foreign bodies fail to pass spontaneously through the gastrointestinal tract in about 20 % of the cases and result in complications in about 1 % of the cases. One of the complications is the migration of the foreign body to the adjacent structure. CASE PRESENTATION: A 25-year-old female lady presented to our hospital with a 15-cm-long coilable and insulated electrical wire foreign body in her abdomen, which extended from the descending colon to the right upper quadrant abdominal wall. Intra-abdominally, the object was located in the general peritoneum without penetrating the bowel or vascular structure. It was complicated by an abdominal wall abscess without any collection in the general peritoneum. The foreign body was then successfully retracted from the abdomen through a right upper quadrant incision without any complications thereafter. CLINICAL DISCUSSION: The uncomplicated passage of foreign bodies through the gastrointestinal tract largely depends on the types of objects. Sharp, elongated objects are more likely to be arrested in the bowel commonly at the point of acute angulation and narrowing. The stacked foreign body may then result in different complications, including penetration and migration of the object. Migration of an insulated electrical wire to the anterior abdominal wall, which we encountered, is extremely rare and can pose a difficulty and dilemma in deciding on management options. CONCLUSION: For an externally accessible, migrated intra-abdominal foreign body that does not result in peritonitis and is confirmed to be located out of the bowel, an exploratory laparotomy could be avoided.

A case report of the rare non recurrent laryngeal nerve in a resource limited setting: The first Ethiopian documentation.

INTRODUCTION AND IMPORTANCE: A non-recurrent laryngeal nerve (NRLN) is an unusual variant of the recurrent laryngeal nerve. It is seen in 0.3-0.8 % of individuals. During neck surgery, the NRLN is predisposed to be injured due to its abnormal anatomic position which results in vocal cord paralysis. CASE PRESENTATION: We report two patients who underwent thyroid surgery. The indication for surgery was controlled toxic diffuse goiter and multinodular goiter with pressure symptoms in the first and second patients respectively. Intraoperatively we employed the lateral approach using the inferior thyroid artery as a landmark to dissect for the RLN. Once we couldn't find the nerve in its normal position the possibility of NRLN came into picture. Through gentle dissection between the larynx and the carotid sheath the nerve was found entering the larynx directly at right angle in both cases and the diagnosis of NRLN was made and intraoperative pictures were taken. CLINICAL DISCUSSION: The NRLN is a rare congenital anomaly of the recurrent laryngeal nerve. It is almost always diagnosed on the right side. Three types have been described. In most cases, the NRLN is diagnosed intraoperative. Both of our patients had type 2A right sided NRLN which was diagnosed intraoperative. CONCLUSION: Through intraoperative careful dissection and search the RLN can be identified and also its rare anomaly, the NRLN, can be diagnosed and injury to the nerve can be avoided.

A giant toxic multinodular goiter extending into the retropharyngeal space: A case report.

INTRODUCTION: In areas with iodine deficiency, multinodular goiter is a prevalent cause of hyperthyroidism. If left untreated, it can grow until it is noticeably huge in size. Although it is a rare clinical phenomenon, thyroid swelling extending into the retro-pharyngeal space presents a substantial difficulty for the surgeon. In this article, we report a giant thyroid mass that had extended to the retro-pharyngeal space and how it posed a challenge during surgery. CASE PRESENTATION: Female, 30-year-old, presented with a huge goiter of 15 years duration which extended to retro-visceral space and completely encircled them without extension to retro-sternal space. After the patient was rendered euthyroid with propylthiouracil (PTU), the thyroid mass was removed surgically. Postoperatively, the patient developed only a transient, asymptomatic hypocalcemia, as a complication. DISCUSSION: If a goiter is large enough, it can grow inferiorly into the mediastinum and outside the typical boundaries of the thyroid bed. However, they rarely grow into the retro-pharyngeal space and present a management issue. The management of this patient was also more complicated as the goiter grew enormous and giant, particularly when it came to controlling the airway and surgically removing the tumor. CONCLUSION: A preoperative CT scan is an important part of diagnostic studies for a giant goiter to diagnose extrathyroidal bed extension. Total or near-total thyroidectomy through a large cervical incision is the mainstay of treatment for such patients to relieve compression symptoms and treat associated hyperthyroidism.